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Intraductal ultrasound of the pancreaticobiliary ductal system

Michael J Levy, MD
Maurits J Wiersema, MD
Section Editor
Douglas A Howell, MD, FASGE, FACG
Deputy Editor
Kristen M Robson, MD, MBA, FACG


The development of endoscopic ultrasound (EUS) in the early 1980s overcame some of the limitations of transabdominal ultrasound for imaging the gastrointestinal tract wall and retroperitoneum [1]. One of the advantages of EUS is the ability to apply the ultrasound transducer directly against the luminal surface, which minimizes intervening adipose tissue and air between the transducer and the target tissue, thereby enhancing image quality. The proximity of the transducer to the target tissue also permits the use of higher frequency ultrasound, which further contributes to the enhanced image resolution. As a result, EUS is used routinely in the evaluation of numerous gastrointestinal disorders, including the diagnosis and staging of gastrointestinal tumors. (See appropriate topic reviews.)

The technical evolution of EUS has lead to the development of small caliber intraductal ultrasound (IDUS) miniprobes (about 2 mm), which can be passed through standard endoscopes directly into the bile or pancreatic duct (picture 1). The small caliber, flexibility, and excellent image quality produced by these catheters makes them ideal for evaluating a variety of biliary and pancreatic disorders (table 1).

This topic review will provide an overview of the role of IDUS in the evaluation of several pancreatic and hepatobiliary disorders. The role of standard EUS instruments in the evaluation of these conditions is presented separately. (See appropriate topic reviews.) The role of miniprobes for evaluation of other parts of the gastrointestinal tract is also discussed elsewhere. (See "High-frequency catheter endoscopic ultrasonography".)


Intraductal ultrasound (IDUS) is capable of producing better image resolution than standard endoscopic ultrasound (EUS; 0.07 to 0.18 mm) [2-4]. Acoustic coupling is optimized by the tubular anatomy of the pancreatic and bile ducts, which are fluid filled and only slightly larger in caliber than the probe itself. In addition, the probes operate at higher frequencies (12 to 30 MHz) than standard EUS, which leads to higher image resolution.

Three systems are available to perform IDUS (table 2):

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Literature review current through: Nov 2017. | This topic last updated: Aug 15, 2016.
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